Summa Health · 1 day ago
Enrollment EDI Analyst
Greater Cleveland
Full-time
Hybrid
Mid Level
$25.54/hr - $38.32/hr
3+ years expSumma Health is an integrated healthcare delivery system that includes Summa Health System hospitals and SummaCare, a regional provider-owned health plan. The Enrollment EDI Analyst will develop and monitor EDI transactions related to membership and enrollments, ensuring efficient processes and compliance with regulations.
Non ProfitHealthcareHealth CareMedical
Responsibilities
Sets up or modifies Trading Partner Rules for new and existing clients
Develops mapping specifications for EDI enrollment, and provides technical support and business analysis during and after implementation of 834 EDI applications
Performs end-user acceptance testing on all inbound and outbound files as them pertain to membership
Processes new EDI enrollments/changes for new and existing clients
Investigates transactions rejected by CMS, FFM and other third party vendors, and takes appropriate action in accordance with defined guidelines
Monitors electronic enrollment transactions in order to identify any issues with load/processing and collaborates with programming and/or clients as needed
Responds to EDI inquiries and issues from external and internal organizations including trading partners, the state and CMS regarding enrollment transactions
Collaborates with management in identifying, defining, and documenting process improvement options and alternatives, as directed by business needs
Promotes and leads process improvement activities and training of department staff and peers
Creates and maintains policies and procedures related to EDI enrollment transactions
Performs all job functions with integrity. Provides timely internal and external customer service in a cooperative, professional, and respectful manner
Qualification
Required
Associates Degree or may substitute with 2 years of like experience
3+ years performing same or similar responsibilities. Relevant experience includes: eligibility, enrollment, premium billing, and/or reconciliation responsibilities in a managed care environment, and/or working knowledge of electronic enrollment transactions and 834 files
Ability to communicate instructional and operational information verbally and in written form that may include correspondence, reports, instructional materials, system designs; ability to provide instruction and guidance required to supervise day-to-day departmental operations; ability to interface with internal staff, mid-upper management professionals and general public
Collecting, analyzing data from diverse sources; making recommendations and/or conclusions based on analyses; developing financial, data processing technical reports, procedures, systems that usually affect one department
Demonstrate high degree of organization and attention to detail
Demonstrate excellent technical skills with the desire and ability to learn new software programs and systems
Demonstrate initiative and ability to work autonomously in a self-directed manner, and transition easily between working alone and working with groups
Operate standard office machines
Organize and manage time to accurately complete tasks within designated time frames in a fast-paced environment
Maintain current knowledge of and comply with regulatory and company policies & procedures
Maintain confidentiality of patient and business information
Flexible: ability to adjust work hours to meet business demands
Ability to effectively interact with populations of patients/customers with an understanding of their needs for self-respect and dignity
Sit for prolonged periods of time
Bend, stoop, and stretch
Manual dexterity to operate computer, phone, and standard office machines
Benefits
Medical
Dental
Vision
Life
Paid time off
Basic Life and Accidental Death & Dismemberment (AD&D)
Supplemental Life and AD&D
Dependent Life Insurance
Short-Term and Long-Term Disability
Accident Insurance, Hospital Indemnity, and Critical Illness
Retirement Savings Plan
Flexible Spending Accounts – Healthcare and Dependent Care
Employee Assistance Program (EAP)
Identity Theft Protection
Pet Insurance
Education Assistance
Daily Pay
Company
Summa Health
Summa Health is a non-profit medical care that offers orthopedic, weight management, sleep medicine, mental, and digestive health services.
5001-10000 employees
Funding
Current Stage
Late StageTotal Funding
$14.6MKey Investors
Jim Oelschlager,Vanita Oelschlager
2024-01-17Acquired
2020-02-07Grant· $1.5M
2019-11-21Grant· $2.1M
Leadership Team
Cliff Deveny
Advisor/CEO Emeritus
Recent News
2025-11-27
Mobihealthnews
2025-11-08
2025-11-02
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